Activity pacing for osteoarthritis symptom management: study design and methodology of a randomized trial testing a tailored clinical approach using accelerometers for veterans and non-veterans

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis (OA) is a prevalent chronic disease and a leading cause of disability in adults. For people with knee and hip OA, symptoms (e.g., pain and fatigue) can interfere with mobility and physical activity. Whereas symptom management is a cornerstone of treatment for knee and hip OA, limited evidence exists for behavioral interventions delivered by rehabilitation professionals within the context of clinical care that address how symptoms affect participation in daily activities. Activity pacing, a strategy in which people learn to preplan rest breaks to avoid symptom exacerbations, has been effective as part of multi-component interventions, but hasn't been tested as a stand-alone intervention in OA or as a tailored treatment using accelerometers. In a pilot study, we found that participants who underwent a tailored activity pacing intervention had reduced fatigue interference with daily activities. We are now conducting a full-scale trial.</p> <p>Methods/Design</p> <p>This paper provides a description of our methods and rationale for a trial that evaluates a tailored activity pacing intervention led by occupational therapists for adults with knee and hip OA. The intervention uses a wrist accelerometer worn during the baseline home monitoring period to glean recent symptom and physical activity patterns and to tailor activity pacing instruction based on how symptoms relate to physical activity. At 10 weeks and 6 months post baseline, we will examine the effectiveness of a tailored activity pacing intervention on fatigue, pain, and physical function compared to general activity pacing and usual care groups. We will also evaluate the effect of tailored activity pacing on physical activity (PA).</p> <p>Discussion</p> <p>Managing OA symptoms during daily life activity performance can be challenging to people with knee and hip OA, yet few clinical interventions address this issue. The activity pacing intervention tested in this trial is designed to help people modulate their activity levels and reduce symptom flares caused by too much or too little activity. As a result of this trial, we will be able to determine if activity pacing is more effective than usual care, and among the intervention groups, if an individually tailored approach improves fatigue and pain more than a general activity pacing approach.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01192516">NCT01192516</a></p

Palestinian and Norwegian Kindergarten Teachers' Perspectives on Psychosocial Support: A Qualitative Study

The current qualitative case study aims to explore and map the concepts and the conditions for providing psychosocial support in kindergarten across two vastly different countries, Palestine and Norway. The global challenge of providing psychosocial support toward children is increasingly acknowledged. Although education is described as crucial for psychosocial support from the health sector, studies dealing with the educational perspective on this topic are rare. Data from 26 participants (10 from Gaza, 10 from Hebron and 6 from Norway) were collected in qualitative semi-structured interviews. Despite vastly different contexts, the analysis showed some important common features. Kindergarten teachers in both countries link psychosocial support conceptually to psychological and emotional knowledge. The teachers in both countries are concerned about the psychosocial support being performed repeatedly in everyday situations, such as establishing routines, paying extra attention, and calming children and creating everyday safe spaces. They give detailed descriptions of the quality of their long-term, yet professional relations with the child. Time and space are crucial challenges in both countries, and they call for more knowledge on mental health. A main difference between the two countries was the role of the community and relation to parents. The Palestinian teachers defined psychosocial support as a “set of community services,” the teachers were frustrated with the lack of parental collaboration. The Norwegian teachers downscaled or overlooked the importance of community or parents and community. The findings give overall presentations of the concepts and the conditions for providing psychosocial support in education Palestine and Norway. We argue that education not only represents sites for conducting health-directed interventions but represents important resources for developing the field of psychosocial support in collaboration with community services. Education – and especially kindergarten provides other values, knowledge, and structural resources for the development programs and knowledge on psychosocial support